Polio vaccine virus-associated meningoencephalitis in an infant with transient hypogammaglobulinemia.

The case of an infant with transient hypogammaglobulinemia who developed meningoencephalitis, retinitis and sensorineural hearing loss is presented. The neurovirulent variant of the Sabin type 2 oral poliovirus vaccine was detected in cerebrospinal fluid and stool.

Comparison between Dawson, Trick, and Litzkow electrode and contact lens electrodes used in clinical electroretinography.

PURPOSE: To determine the reliability of the Dawson, Trick, and Litzkow (DTL) electrode in electroretinographic recordings (ERG) in subjects of all ages, we evaluated ERG responses obtained with the contact lens (CL) and DTL electrodes and estimated a DTL/CL ratio for each sample. METHODS: Seventy-nine volunteers aged 2-84 years (79 normal eyes) were recruited for the study. Electroretinographic recordings elicited by monocular single-flash stimuli delivered by an automatic ERG recording system were recorded using both CL and the DTL electrodes (CL-ERG and DTL-ERG, respectively). RESULTS: The relative amplitude of the DTL-ERG to the CL-ERG was 79.6-99.8% (mean = 93.4%) for the a-wave and 84.4-106.3% (mean = 92.3%) for the b-wave. The relative latency of the DTL-ERG to the CL-ERG was 86. 0-107.6% (mean = 98.2%) for the a-wave and 96.1-113.0% (mean = 97. 9%) for the b-wave. The a- and b-wave amplitudes differed significantly between DTL and CL electrodes only in the 40- to 49-year-old age groups (P <.05). Regression analysis indicated moderate to strong relationships between the electrodes for amplitude (a-wave, r = 0.690; b-wave, r = 0.824) and latency (a-wave, r = 0.667; b-wave, r = 0.725). CONCLUSION: The DTL electrode has as high stability as the conventional CL electrodes for ERG recordings in most age groups.

Triple carcinomas of the biliary tract associated with congenital choledochal dilatation and pancreaticobiliary maljunction.

We report a rare case of triple carcinomas of the biliary tract associated with congenital choledochal dilatation (CCD) and pancreaticobiliary maljunction (PBM). The patient was a 58-year-old Japanese man who complained of epigastralgia. Ultrasonography and computed tomography revealed an elevated lesion inside the markedly dilated extrahepatic bile duct, thickening of the gallbladder wall, and small polypoid lesions in the gallbladder. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography showed CCD and PBM. With a diagnosis of carcinoma of the bile duct and cholesterol polyps in the gallbladder, pylorus-preserving pancreaticoduodenectomy was performed. The resected specimen showed two elevated lesions in the dilated bile duct, cholesterol polyps, and an area of irregular mucosa in the gallbladder. Histopathological examination showed two carcinomas in the bile duct, an adenosquamous cell carcinoma, and a moderately differentiated tubular adenocarcinoma, and a well differentiated tubular adenocarcinoma of the gallbladder. Two years and 6 months after the operation, a solitary metastatic liver tumor was detected. Left hepatic lobectomy was performed. At present, 7 months after the second operation, the patient is doing well with no signs of recurrence. Multiple carcinomas in the biliary tract associated with CCD and PBM, including the details in the present patient, were reviewed.

[A familial case of proliferative diabetic retinopathy associated with a mutation in the mitochondrial gene].

We report a 39-year-old male patient with proliferative diabetic retinopathy associated with a mutation in the mitochondrial DNA and with his family. The patient was referred for fundus examination in 1993. He had been diagnosed as having diabetes mellitus 15 years before but his diabetic control was not good. He was thin and short and presented with bilateral proliferative diabetic retinopathy. When he received pan retinal photocoagulation, an exudative retinal detachment was found in his left eye, but it disappeared spontaneously. The patient's history included sensorineural deafness and autonomic nerve system disorder. Mitochondrial analysis obtained from blood showed mutation of adenine to guanine at mitochondrial DNA 3243. Generally speaking, mitochondrial disorders often include pigmentary degeneration. For this reason diabetic patients with mitochondrial disorders rarely suffer proliferative diabetic retinopathy. In this case, the retinitis pigmentosa was not so severe as to cause the proliferative change, so that it was probably derived from heteroplasmy.

The multifocal electroretinogram in retinal detachment.

We evaluated the retinal electrophysiologic function in both the detached and attached areas of eyes with retinal detachment, and assessed the functional recovery of these areas after surgery by quantifying the results obtained from multifocal electroretinograms. Multifocal electroretinographic recordings and central 0 degrees to 30 degrees visual field tests were performed preoperatively and 2 weeks 1, 3 and 6 months postoperatively in 12 patients with unilateral retinal detachment. Each patient's response to the multifocal electroretinogram and the visual field test was classified into two groups: group A, the response from the attached area; and group B, that from the detached retinal area. Individual mean deviation and percentage mean deviation were calculated for each group. All retinal detachments were successfully reattached by the conventional scleral buckling method. The retinal sensitivity in the visual field test of all the patients in group B greatly improved. However, the percentage mean deviation in the response density of the multifocal electroretinogram in group B was -81% preoperatively and -63% at 6 months postoperatively. Thus, the improvement was confined within narrow limits. The response density of the multifocal electroretinogram in group A was very low, and never improved beyond -50% of percentage mean deviation. In the eyes with retinal detachment, clectroretinogram response in both the attached and detached areas was more disturbed than predicted by means of the visual field test during the course of this study.

[Combination therapy of ESWL and PNL for the staghorn calculi].

We have been engaged in the treatment of urinary tract calculi using extracorporeal shockwave lithotripsy (ESWL) and endourology techniques for more than 8 years. In the treatment of thin staghorn calculi, ESWL monotherapy is the first choice. On the other hand, combination of percutaneous nephrolithotomy (PNL) and ESWL is important for the treatment of thick staghorn calculi in order to avoid the stone street and side effects of shock waves. When the stone is made of hard components such as calcium oxalate monohydrate and cystine, combination of both methods is also useful. In the case of complicated staghorn calculi with isolated branches, open surgery such as nephrolithotomy or partial nephrectomy might be the choice.

[Utility of recombinant human erythropoietin on the anemia of elderly hemodialysis patients].

Recombinant human erythropoietin was administered to 59 patients over 65 years of age receiving maintenance hemodialysis treatment in Kyoto and Shiga district, in order to evaluate its utility on renal anemia. After 6 months of administration, the hematocrit rose from 20.8 +/- 3.5% to 28.0 +/- 3.7% with concomitant improvement of subjective symptoms related to anemia. Twelve patients developed side effects, in 10 of whom elevation of blood pressure was observed. We found no clinically significant abnormalities in the laboratory data. In conclusion, recombinant human erythropoietin is highly useful in the treatment of renal anemia in elderly hemodialysis patients.

[The effects of preoperative insertion of double-J catheter in transurethral lithotripsy (TUL)].

Transurethral lithotripsy (TUL) was performed in the cases in which the ureteral calculi were not destroyed by the extracorporeal shock-wave lithotriptor (Dornier HM-3, EDAP LT 01). Preoperative placement of double-J ureteral catheter (D-J catheter) caused ureteral dilation, allowing smooth insertion of the ureteroscope. We divided the 55 TUL cases into two groups, those with (27) or without (28) a D-J catheter placed preoperatively, and compared requirement of ureteral bougination, difficulty of ureteroscope insertion and duration of operation between the two groups. In all cases with a D-J catheter, ureteral bougination was not necessary, the insertion of ureteroscope was easier and the duration of operation was shorter than the cases without a D-J catheter. Bladder irritable symptoms were seen in some cases with a D-J catheter but did not require removal of the D-J catheter. On the follow-up term after TUL, there was no difference in the incidence of postoperative fever or postoperative ureteral stenosis, between the cases with and those without a D-J catheter.

[The pitfall of ESWL].

The pitfall of extracorporeal shock-wave lithotripsy (ESWL), such as complications of ESWL, problems of focus and results of stone disintegration are discussed. The progress of ESWL today is mainly due to the development of new generation lithotripters and endourological support, which has broadened the indications of ESWL. The necessary shock-waves have been selected, and complications have been reduced. Post ESWL stone street is now easier to treat. We expect more improved lithotripters such as by incorporation of X-ray and echo focusing systems. Endourological techniques including laser lithotripsy also should be improved.

[The relationship between opsonin, endotoxin and chemical mediators in postoperative complications after surgery].

The role of various chemical mediators in the development of complications after major surgery was investigated. Phospholipase A2 activity (PLA2), and the levels of pancreatic secretory trypsin inhibitor (PSTI), polymorphonuclear leukocyte elastase (PMNE), thromboxane B2 (TxB2), 6-keto-PGF1 alpha (6-KF), leukotriene (LT) B4, C4, D4, interleukin-beta (IL-1 beta), tumor necrosis factor (TNF), and endotoxin (Et) in the serum were measured in 134 surgical patients of whom 36 developed postoperative complications. PLA2, arterial TxB2 and 6-KF showed significant changes in the patients with post-operative complications, associated with elevated Et levels. The majority of these patients had a significantly higher ratio of TxB2/6-KF. These results suggest TxB2 and 6-KF, and the TxB2/6-KF ratio are useful indices of outcome in critically ill patients with hepatic failure. Our findings revealed marked production of prostanoids in sepsis and indicate a severity of the complication in balance of the thromboxane/prostacyclin axis. It was also suggested that the opsonin and eicosanoid levels are closely related to the serum endotoxin level. LTB4, C4 and D4 were increased in the patients with postoperative sepsis or DIC, especially at the initial onsets. The increased levels of IL-1 beta or TNF were observed in some patients with postoperative complications, especially those with severe postoperative complications.

[Beneficial effect of zinc supplementation on pruritus in hemodialysis patients with special reference to changes in serum histamine levels].

Persistent pruritus is one of the most common symptoms in hemodialysis patients. The cause of pruritus is not known, and conventional treatment for pruritus is rarely helpful. Some authors thought that release of histamine from increased mast cells in uremic patients was the cause of pruritus. On the other hand, there have been a number of reports suggesting that uremic patients are zinc deficient. In vitro as well as in vivo studies have demonstrated that zinc has an inhibitory effect on various functions of some cells, such as histamine release from mast cells. In this study, we examined the serum zinc and histamine levels in 19 hemodialysis patients with persistent pruritus and the effect of zinc supplementation on the pruritus. In patients with pruritus, the serum zinc level decreased and serum histamine level increased, showing a negative correlation between them. Oral zinc sulfate, 445 mg daily for two months, relieved pruritus subjectively in 53% of the patients. After treatment, serum histamine levels decreased significantly, as well as serum zinc levels increased significantly. These findings suggest that zinc deficiency participates in increased histamine levels in dialysis patients, and subsequently in the development of uremic pruritus.

Inhibition of neuronal Cl-stimulated Mg-ATPase by alpha-human atrial natriuretic polypeptide.

Effects of alpha-human atrial natriuretic polypeptide (alpha-hANP) on neuronal membrane-bound adenosine triphosphatases (ATPases) (Na, K-ATPase, Cl-stimulated Mg-ATPase and anion-insensitive Mg-ATPase) were examined using rat brain microsomes. This peptide inhibited Cl-stimulated Mg-ATPase in a dose-dependent manner. The inhibition was non-competitive with respect to ATP, and was not affected by Cl-, the most potent stimulator of this enzyme. The activities of Na,K-ATPase and anion-insensitive Mg-ATPase were not changed by alpha-hANP at all.